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Objectives Dermatomyositis (DM) is an autoimmune disease that presents with a wide variety of clinical manifestations. Patients with DM or clinically amyopathic dermatomyositis (CADM) with antimelanoma differentiation‐associated protein 5 (anti‐MDA5) antibodies are frequently associated with interstitial pneumonia, especially rapidly progressive interstitial lung disease. Progranulin (PGRN) is an autocrine growth factor involved in inflammation. Elevated serum PGRN levels have been reported in the patients with systemic lupus erythematosus and rheumatoid arthritis. However, they have not been precisely studied in DM/CADM. We assessed PGRN levels as a potential biomarker for DM/CADM with anti‐MDA5 antibodies. Methods Twenty‐four DM/CADM patients with anti‐MDA5 antibodies, 12 patients without anti‐MDA5 antibodies, and eight healthy volunteers were enrolled. We measured serum PGRN levels and compared them between the anti‐MDA5 antibody‐positive and antibody‐negative groups. They were also measured before and after the start of treatment in anti‐MDA5 antibody‐positive patients. We examined the correlations between serum PGRN levels and laboratory data such as serum KL‐6 and ferritin levels. Results Patients with DM/CADM, especially those with anti‐MDA5 antibodies, had significantly higher serum PGRN levels than healthy individuals. They decreased after the start of treatment. Serum PGRN levels were positively correlated with serum KL‐6 and ferritin levels, and anti‐MDA5 antibody titers. Conclusions This is the first study to show that PGRN levels were significantly elevated in the sera of DM/CADM patients, particularly in those with anti‐MDA5 antibodies. PGRN may be a useful biomarker of disease activity. However, further studies are required to reveal the mechanisms of PGRN in DM/CADM more precisely.

This article describes the first reported case of myasthenia gravis (MG) seropositive for both acetylcholine receptor antibody and low-density lipoprotein receptor-related protein 4 antibody, complicated by autoimmune polyglandular syndrome (APS) type 3. The patient exhibited myasthenic weakness restricted to the ocular muscles and ptosis. Severe clinical deterioration ensued with predominant bulbar symptoms. MG rapidly worsened, the patient was intubated, and agranulocytosis due to thiamazole was also present, so it was necessary to perform thyroidectomy with tracheostomy and thymectomy in two phases. Both the double-seropositive MG and the APS were involved in the patient's rapid deterioration.

Sweet’s syndrome is a neutrophilic dermatosis characterized by an abrupt onset of painful erythematous lesions showing neutrophilic infiltrates in the dermis. Fever and an elevated neutrophil level are generally observed. Sweet’s syndrome may be idiopathic, malignancy-associated, or drug-induced (mainly involving granulocyte colony-stimulating factor (G-CSF) administration). Although systemic corticosteroids are usually effective, the symptoms of Sweet’s syndrome recur in some refractory cases. Herein, we report a case of a 55-year-old Japanese woman with recurrent symptoms of fever (>39°C) and painful erythematous lesions on her four extremities, trunk, and neck. Laboratory findings revealed leukocytosis and high levels of C-reactive protein (CRP) and G-CSF. She was diagnosed with a recurrence of Sweet’s syndrome, and was exclusively treated with granulocyte and monocyte adsorption apheresis (GMA) therapy once a week for 3 consecutive weeks. After the first session of GMA therapy, all symptoms including the erythematous lesions and fever were completely resolved, and serum G-CSF level was reduced. Leukocyte count, neutrophil count, serum amyloid A protein, and CRP levels were restored within normal ranges by 2 weeks. Thus, GMA therapy can successfully treat a patient with recurrent Sweet’s syndrome, potentially related to the restoration of elevated serum G-CSF levels.

Graves' disease (GD) and Hashimoto's disease (HD) are autoimmune thyroid disorders distinguished by the presence or absence of antithyrotropin receptor (TSHR) antibodies (TRAb). TSHR gene polymorphisms determine the amount of TSHR expressed, which may in turn influence TRAb production. The FANTOM5 project identified six GD-associated single nucleotide polymorphisms (SNPs) within the enhancer regions of the TSHR and unknown genes. This study examined the association of 11 TSHR and unknown gene polymorphisms, five of which are located in TSHR enhancer regions, with the development and prognosis of GD and HD.SNPs of the TSHR and unknown genes were genotyped in 180 GD patients, including 62 patients with intractable GD and 48 patients with GD in remission; 151 HD patients, including 65 patients with severe HD and 40 patients with mild HD; and 111 healthy controls.The rs4411444 GG genotype and G allele, the rs2300519 AA genotype, and the rs179247 AA genotype and A allele were more frequent in GD patients than they were in controls. These same genotypes and alleles, in addition to the rs2300519 A allele and rs4903961 GG genotype and G allele, were more frequent in patients with intractable GD than they were in controls and patients with GD in remission. Interestingly, the rs2300519 TT genotype and T allele, rs4903961 CC genotype and C allele, and rs179247 GG genotype, all of which are minor genotypes and alleles among the evaluated SNPs, were more frequent in HD patients than they were in controls, but there were no differences in the frequencies of these genotypes and alleles between patients with severe HD and mild HD. Among the evaluated SNPs, the rs4411444 GG genotype and the rs4903961 C allele in the enhancer regions of the TSHR gene were most strongly associated with the development of GD, especially intractable disease, and that of HD, respectively.Among the evaluated TSHR gene SNPs, the rs4411444 GG genotype and the rs4903961 C allele in the enhancer regions of the TSHR gene were most strongly associated with the development of GD, especially intractable disease, and that of HD, respectively.

釣藤散が有効な頭痛の患者タイプを多変量解析により検討した。51名の頭痛患者に対して随証治療にて釣藤散を投与し，このうち1カ月間服用した46名（男性13人，女性33人，中央値48歳，範囲19－77歳，片頭痛31例，緊張型頭痛14例，混合型頭痛1例）を対象とした。随伴症状，体質傾向，舌所見，腹部所見，年齢，性別，身長，体重，高血圧の有無の計38項目を説明変数とし，頭痛改善の有無を目的変数として，多次元クロス表分析により最適な説明変数とその組み合わせを検討した。この結果，単変量解析では，重要な順に「朝の頭痛」，「めまい・ふらつき感」，「不眠」，「体重」，「耳鳴」，「舌下静脈怒張」となった。これは，「朝の頭痛」という口訣を統計学的に支持する結果となった。多変量解析では，「朝の頭痛」，「舌下静脈怒張」と「頸肩こり」の組み合わせが，釣藤散による頭痛改善を予測する最適なモデルとなった。抑肝散証では「背中の張り」を重視するのに対して，釣藤散では「頸肩こり」が頭痛改善を予測する情報として有用であったことは，両者の鑑別に役立つものと考えられた。

Antioxidative effects of Taheebo extract, obtained from the bulk of Tabebuia avellanedae Lorents and Griseb, were examined by two assay methods for radical scavenging activity on DPPH and inhibitory effect on linoleic acid peroxidation. In the case of the DPPH method, Taheebo showed the electron donating ability to DPPH and its ability corresponded to that of trolox in the present experimantal condition. On the other hand, in the autoxidation of liloleic acid, Taheebo extract showed the most inhibitory effect in teas tested (green tea and oolong tea.). These results suggested that Taheebo extract was a desirable antioxidant.

Aim: Premenstrual syndrome (PMS) affects 40–80% of women. Japanese herbal medicine, known as Kampo, is frequently prescribed for PMS, so we examined the efficacy of Kamishoyosan using two methods: first, the second derivative of the fingertip photoplethysmogram (SDPTG) evaluating vascular age (VA), and second, a self-assessment questionnaire on subjective symptoms. Methods: The SDPTG was recorded in 45 patients with PMS (mean ± SD = 32 ± 6 years of age) before (0 M), on the first (1 M) and third (3 M) month of therapy. Patients answered a questionnaire (44 questions) on their complaints every month. The reproducibility of the SDPTG was confirmed with 15 normal volunteers (33 ± 9 years of age). Results: In patients with older VA than their chronological age (Age) before therapy, we found linear correlations of the VA–Age differences at 1 M versus 0 M (y = 0.45x + 1.59, standard error of estimate [SEE] = 6.13 years), and at 3 M versus 0 M (y = 0.18x + 4.09, SEE = 6.03 years). The VA–Age decreased from 11.3 ± 6.4 (0 M) to 6.6 ± 6.7 (1 M) and 6.1 ± 6.0 years (3 M) (P